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Breast stimulation for cervical ripening and induction of labour

Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates.

Breast stimulation causes the womb to contract, though the mechanism remains unclear. It may increase levels of the hormone oxytocin, which stimulates contractions. It is a non-medical method allowing the woman greater control over the process of attempting to induce labour. The review of six trials (719 women) found insufficient research to evaluate the safety of breast stimulation in a high-riskpopulation and until safety issues have been fully evaluated, it should not be considered for use in this group.

Authors' conclusions:

Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates. Until safety issues have been fully evaluated it should not be used in high-risk women. Further research is required to evaluate its safety, and should seek data on postpartum haemorrhage rates, number of women not in labour at 72 hours and maternal satisfaction.

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Background:

Breast stimulation has been suggested as a means of inducing labour. It is a non-medical intervention allowing women greater control over the induction process. This is one of a series of reviews of methods of cervical ripening and labour induction using a standardised methodology.

Objectives:

To determine the effectiveness of breast stimulation for third trimester cervical ripening or induction of labour in comparison with placebo/no intervention or other methods of induction of labour.

Search strategy:

The Cochrane Pregnancy and Childbirth Group's Trials Register (15 September 2009) and bibliographies of relevant papers.

Selection criteria:

Clinical trials of breast stimulation for third trimester cervical ripening or labour induction.

Data collection and analysis:

A strategy was developed to deal with the large volume and complexity of trialdata relating to labour induction. This involved a two-stage method of data extraction.

Main results:

Six trials (719 women) were included.

Analysis of trials comparing breast stimulation with no intervention found a significant reduction in the number of women not in labour at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, 95% confidence interval (CI) 0.60 to 0.74). This result was not significant in women with an unfavourable cervix. A major reduction in the rate of postpartum haemorrhage was reported (0.7% versus 6%, RR 0.16, 95% CI 0.03 to 0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38 to 2.12) or rates of meconium staining. There were no instances of uterine hyperstimulation. Three perinatal deaths were reported (1.8% versus 0%, RR 8.17, 95% CI 0.45 to 147.77).

When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% versus 47%, RR 0.60, 95% CI 0.31 to 1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% versus 25%, RR 2.35, 95% CI 1.00 to 5.54) or rates of meconium staining. There were four perinatal deaths (17.6% versus 5%, RR 3.53, 95% CI 0.40 to 30.88).